Pulse articles from July 2008

Pulse archives from July 2008

GPs to be paid to battle for patients.
July 9, 2008... MPIG to make way for expanding practice incentives as Darzi review ratchets up competition By Steve Nowottny GPs are to be paid to battle each other for patients as part of a Government drive to intensify competition and widen...

Call to allow abortions in GP practices.
July 9, 2008... Plans for abortions to be carried out in GP practices moved a step nearer this week as the fpa (formerly the Family Planning Association) called for the move as part of proposed amendments to the Human Fertilisation and Embryology Bill. A...

BMA chair urges end to market in healthcare.
July 9, 2008... BMA chair Dr Hamish Meldrum has called on the Government to scrap the market economy in English healthcare. In his keynote speech at the association's annual conference in Edinburgh this week, Dr Meldrum told more than 400 UK doctors that...

Warning over infant vaccine shortfall.
July 9, 2008... GPs are being warned that they will receive a reduced allocation of pre- school booster vaccines after a national shortage forced the Department of Health to cut supplies to practices. In the June issue of the department's vaccine supply...

Darzi review: QOF to get tougher, go local and focus on public health.
July 9, 2008... GP leaders fear targets could be imposed on profession as ministers pledge to consult NICE on new indicators By Lilian Anekwe GPs face a radical reshaping of the QOF, with tougher targets based increasingly on outcomes rather than...

Darzi review: GPs to publish `quality accounts'.
July 9, 2008... The Government will publish a raft of new data about GPs in a bid to rigorously police standards and allow patients to make informed choices about practices. One of a host of new measures will require GPs to produce `quality accounts',...

Darzi review: Darzi drops all reference to p-word.
July 9, 2008... Lord Darzi jettisoned the word `polyclinic' from his report because the Department of Heath feared its very mention had become damaging. The p-word does not feature once in the NHS Next Stage Review, with Lord Darzi telling the House of...

Darzi review: Workload fears over 15 million care plans.
July 9, 2008... GPs have expressed alarm at the added workload of giving all 15 million patients with long-term conditions personal care plans in the next two years. Their concern came after the Government made personal care plans a central plank of its...

Darzi review: CVD screening model under fire.
July 9, 2008... Evaluation branded `totally unrealistic' in assuming screening will take up just 12 minutes a week of GP time By Nigel Praities Government plans to offer vascular checks to three million patients a year are based on economic modelling...

Darzi review: PBC revamp `not enough'.
July 9, 2008... A leading adviser to Lord Darzi has criticised the minister's NHS Next Stage Review for failing to do enough to salvage practice-based commissioning. Lord Darzi's report pledged to `redefine and reinvigorate' the flagging health policy,...

Darzi review: Plan sets out drugs promise.
July 9, 2008... GPs will be able to demand PCTs fund NICE-approved treatments they deem appropriate for their patients under the proposed NHS Constitution. The uptake of treatments approved by NICE can vary in different parts of the country, despite a...

Darzi review: GP training gets tougher as pass rates fall under nMRCGP.
July 9, 2008... Exclusive By Nigel Praities Completing general practice training has become tougher following last year's introduction of the new MRCGP exam, reveal figures obtained by Pulse from the RCGP. Pass rates were 81% for the clinical...

Polyclinics: Polyclinic plans `veiled in secrecy'.
July 9, 2008... Trusts held secret talks with private firm before public had been consulted on whether plans should go ahead PULSE: SOS - Save Our Surgeries Exclusive By Steve Nowottny Two north London trusts held secret talks with a private...

Polyclinics: Advice on fighting polyclinic threat.
July 9, 2008... GP leaders have drawn up battle plans to help hundreds of practices that face being moved or closed because of the Government's polyclinics drive. Londonwide LMCs has compiled a 50-page document, designed as a detailed practice...

Safety: Study finds in favour of GP minor surgery.
July 9, 2008... Researchers reopen row over GP skin cancer surgery - insisting it is safe By Emma Wilkinson GP researchers have delivered a strong riposte to a recent NHS study branding minor surgery carried out in primary care as `unsafe'. A...

Criticism: Skin audits fuel minor surgery row.
July 9, 2008... Dermatologists have courted further controversy over primary care management of skin cancer, after launching a concerted attack on GPs at their annual conference. Three audits presented at the British Association of Dermatologists meeting...

IN BRIEF: ARB stroke benefits.
July 9, 2008... GPs may want to choose ARBs over ACE inhibitors in patients at high risk of stroke, results from a meta-analysis suggest. The risk of a stroke in patients on ARBs was 8% lower than with ACE inhibitors, the analysis of data from six trials...

IN BRIEF: Plan for GP federations.
July 9, 2008... GP practices should club together to form `primary care federations' in order to improve patient services and make best use of existing premises, according to a report published by the RCGP. Under the proposals, groups of neighbouring...

IN BRIEF: Primary angioplasty rise.
July 9, 2008... An increasing minority of patients are now having primary angioplasty in the event of a heart attack, but access to the treatment varies widely from area to area, national audit results show. About 20% of patients now have the treatment -...

IN BRIEF: Error over clopidogrel cuts.(Brief article)
July 9, 2008... A Government push to reduce clopidogrel prescribing in primary care may be focusing on the wrong PCTs, researchers warn. An analysis of a National Audit Office indicator for trust performance shows it may incorrectly identify trusts as high or...

GPs face bills of #90,000 to mount APMS bids.
July 9, 2008... GPs will be landed with bills of up to #90,000 when bidding for APMS practices and polyclinics, writes Gareth Iacobucci. The daunting estimate adds to evidence of the uphill struggle GPs face to match the financial muscle of the private...

Property firms eye `healthcare haven'.
July 9, 2008... GPs face a wave of practice consolidations and surgery closures as a result of the Government's plans to transfer specialist services into primary care, property experts are predicting. A report for property investment companies says...

GMC cases against GPs on the up.
July 9, 2008... Fears of backlash following negative publicity as proportion of fitness- to-practise cases involving GPs increases Exclusive By Gareth lacobucci Cases against GPs are making up a rising proportion of GMC fitness-to- practise...

Journal watch: Heart treatment risk.
July 9, 2008... Invasive treatment such as cardiac recatheterisation may increase the risk of heart attack and death in some women despite being a useful strategy for male patients, a meta-analysis shows. Researchers assessed data on immediate cardiac...

Journal watch: Antidepressants in young.
July 9, 2008... Antidepressants show only limited activity in children and adolescents although the benefit may increase with age and be greater with fluoxetine, a meta-analysis shows. A team of UK and US researchers analysed data from 30 studies...

Journal watch: Dangers of high albumin.
July 9, 2008... Apparently healthy women with levels of albumin that are high but within the normal range have a raised risk of hypertension, say US researchers. Their study examined 2,179 women without hypertension or diabetes at baseline and with normal...

Journal watch: Silent strokes common.
July 9, 2008... Substantial numbers of apparently healthy middle-aged people suffer from silent strokes, US research suggests. An analysis of MRI data from 2,000 people taking part in the Framingham Offspring Study identified silent cerebral infarction in...

UK disparities widen on extended hours DES.
July 9, 2008... Extra #2.65m made available for nurse support - but only in Scotland By Gareth Iacobucci Divisions between the different UK countries over implementation of the extended hours DES have widened after Scottish GPs were handed extra cash...

PCTs to get PAD framework.(Brief article)
July 9, 2008... PCTs will be encouraged to improve the management of peripheral arterial disease in national guidance to be released by the Government next year, Pulse can reveal. The Department of Health is working on a primary care service framework...

Evidence for CBT access drive questioned.(cognitive behaviour therapy)(Brief article)
July 9, 2008... Researchers have questioned the evidence for the Government's psychological therapy drive. A systematic review of the economic evidence for the rollout of the #170m Improving Access to Psychological Therapies (IAPT) scheme found only two...

Media Watch: This week's top... Miracle cure.
July 9, 2008... Bringing a whole new meaning to the phrase hung like a hamster, the Daily Mail reports on Australian research in hamsters that shows suppressing the production of sex hormones in Sertoli cells, which are involved in the development of sperm,...

Media Watch: This week's top... Scare story.
July 9, 2008... Nightmares about dentists are likely to be even more horrific now - that's if you can find one on the NHS, of course. The US Food and Drug Administration has warned mercury fillings could be toxic. The Daily Mail and Daily Telegraph claim...

Media Watch: This week's top...most pointless research.
July 9, 2008... Takeaways are officially bad for you, according to a consumer survey. A study by Which? reveals that there are unpalatable levels of saturated fats, salt, sugar and calories laden in Chinese and Indian takeaways and pizzas. Which? insisted it...

CVD targets drive down deaths.
July 9, 2008... GP pioneer reveals 79% cut in CVD mortality after two decades of intensive treatment By Nigel Praities Aggressive treatment of cardiovascular risk factors in general practice can produce dramatic reductions in mortality, reveals an...

NICE gives go-ahead for rimonabant.(National Institute for Clinical Excellence)(Brief article)
July 9, 2008... NICE has given the go-ahead for use of rimonabant in obese patients who cannot take orlistat and sibutramine or have failed to lose weight on them. Its guidance comes despite a flurry of recent reports linking the weight-loss drug to an...

Darzi digest: Darzi sets out vision for future of the NHS.(National Health Service)(Minimum Practice Income Guarantee )
July 9, 2008... Lord Darzi's long-awaited NHS Next Stage Review is out. Here's what it means for GPs By Pulse news desk It is, we are told, the review to end all reviews. Described by health secretary Alan Johnson as `the most important development in...

Editorial: No place for cash prizes for patients.(Editorial)
July 9, 2008... Health secretary Alan Johnson is not a man for studied understatement. He led the build-up to Lord Darzi's Next Stage Review by describing it as `the most important development in the history of the NHS'. With a billing like that, the review...

Vox pop: Is Darzi's medicine a cure for the NHS's ills?
July 9, 2008... Dr Chaand Nagpaul GPC negotiator and a GP in Stanmore, Middlesex `It's like a medicine bottle with a glossy label but no medicine inside. Once again, we have a report driven by ideology rather than understanding frontline clinicians. It's...

Debate: Should GP practices offer abortion?
July 9, 2008... YES Restrictions preventing provision of abortion in general practice are unnecessary, outdated and deny women the chance for integrated care, argues MP Dr Evan Harris The Abortion Act is now 40 years old, so it is not surprising that...

PulseClinical: DEMENTIA.
July 9, 2008... Old-age psychiatrist Professor Clive Ballard answers GP Dr Steve Brown's burning questions Take-home points * Mini mental state examinations are useful for screening, but are not sensitive as a measure of change * Visual...

PulseClinical: HOW NOT TO MISS... HERPES SIMPLEX KERATITIS.(Disease/Disorder overview)
July 9, 2008... Ophthalmologist Dr Scott Fraser on what you need to do to make sure you don't miss this serious eye infection Worst outcomes if missed Herpes simplex virus infections of the cornea can cause a profound impairment of vision in the...

PulseClinical: BACK PAIN.
July 9, 2008... Professor of complementary medicine Edzard Ernst and colleagues look at which therapies work, which don't and which might cause harm in treating back pain Back pain is the most frequent reason for people to try complementary and...

PulseClinical: SPONDYLOARTHRITIS.
July 9, 2008... Musculoskeletal GPSI Dr Louise Warburton offers her tips on diagnosing this closely related group of inflammatory diseases 1 The incidence of the spondyloarthritides (SpAs) is as high as 1-2% in Europe, making them as common as rheumatoid...

SNAPSHOT: DIAGNOSIS - LUMP ON THE GUM.(Case study)
July 9, 2008... Dr Mike Wyndham on a mouth swelling that was alarming this smoker The patient This 63-year-old lady had noticed a progressive development of a swelling on her lower gum. There was some discomfort but nothing that could not be...

PulseClinical: DEHYDRATION IN CHILDREN.
July 9, 2008... Dr Nick Summerton shows how numerical data derived from the history and examination can help in diagnosing dehydration in children Dehydration is often a concern when dealing with children suffering vomiting, diarrhoea or a poor oral fluid...

Asktheexpert: PATIENT REGISTRATION.
July 9, 2008... Dr Emma Cuzner, MDU medicolegal adviser, offers advice on treating your own staff when it is not practical for them to register elsewhere We have just recruited someone to our reception team. She is registered with us as a patient. We are...

Businessbriefing: NATIONAL INSURANCE.
July 9, 2008... In a new series on financial MOTs, accountant Bob Senior advises how to ensure you don't overpay Q Although people dislike paying tax, they generally expect that HM Revenue and Customs will sort out what they owe. And generally they are...

PulseServices: Beat the taxman over inheritance.
July 9, 2008... Inheritance tax rules have just improved - but there are even better ways to save your assets, says Stuart Smith Tax legislation is subject to change, and its value will depend on individual circumstances. The value of investments can fall...

Copperfield: Wrong - and proud of it.
July 9, 2008... At least medicine admits when it has made a mistake and learns from it - unlike carved-in-stone alternative therapies, says Copperfield I was having a stand-up fight the other night. Actually, as we were in a restaurant it was more of a...

DH forces PCTs to procure polyclinics.
July 23, 2008... Pulse: SOS - Save Our Surgeries Exclusive By Steve Nowottny The Government is forcing PCT bosses to press ahead with a rollout of polyclinics even where they have protested that the move could `jeopardise' patient care, Pulse can...

GPs may have to wait months for pensions rebate.
July 23, 2008... Recently retired GPs who lost thousands of pounds due to the Government's unlawful cap on GP pensions may have to wait months to receive their compensation, Pulse can reveal. BMA leaders met Department of Health officials last week to begin...

QOF exception reporting could net #15,500.
July 23, 2008... An average-sized practice could theoretically earn up to #15,500 from QOF exception reporting, an analysis of general practice data has shown. The study, published in the New England Journal of Medicine, found that GPs earned a median of...

DH criticised over choice of cervical vaccine.
July 23, 2008... A stinging editorial in the BMJ has criticised the Department of Health's decision to choose a bivalent rather than a quadrivalent vaccine for the HPV vaccination campaign. Professor Jane Kim, a specialist in health policy and management at...

Three years on, PBC is still stranded on starting grid.
July 23, 2008... Pulse investigation finds trusts are unable to produce any evidence of benefits as support for GPs gets worse Exclusive By Gareth Iacobucci Practice-based commissioning is stranded on the starting grid, with only the flimsiest of...

GPC backs practice accreditation plans.
July 23, 2008... The GPC has formally backed conroversial plans for practice accreditation, insisting that they will protect GPs from being `attacked and denigrated'. Dr Laurence Buckman, GPC chair, said the organisation was fully behind the RCGP's...

This is our chance to seize the initiative.(Editorial)
July 23, 2008... Guest Editorial Pulse's guest editor Professor Mike Pringle gives his take on this week's news There will be more than a million GP consultations in the UK today. Almost all will be excellent, with good outcomes, appropriate use of...

BECOMING A WOMAN: GP leader opts to change gender.
July 23, 2008... Horror of 7/7 attack convinced Dr Michelle Drage - formerly Stewart Drage - to undergo gender reassignment By Lilian Anekwe Facing the carnage of the 7/7 bus bombing outside BMA House gave the GP leader formerly known as Dr Stewart...

Dr Beth McCarron-Nash replaces Drage as negotiator.
July 23, 2008... The woman who spearheaded the BMA's PR campaign to win public support against the Government has been elected the newest - and sole female - GPC negotiator. Dr Beth McCarron-Nash, a GP in Honiton, Devon, helped the GPC gather 1.2 million...

Deal over MPIG releases #50m funding.(Minimum Practice Income Guarantee )
July 23, 2008... GPs are at last set to gain access to #50m of new clinical funding after ministers agreed a deal with the GPC to end the long-standing deadlock over this year's pay award. But nine of out 10 practices will see their funding frozen under...

How will deal affect GPs?
July 23, 2008... * GP practices that do not rely on that MPIG - about one in 10 of the total - will receive their additional funding for 2008/9 as a lump sum backdated until April. Their annual global sum payment will be uplifted by 2.7%. * Pay for...

Battle for patients drives increase in extended opening.
July 23, 2008... Competition among GPs for patients is the driving force behind sharp increases in the number of practices offering evening and weekend appointments, ministers claim. Department of Health figures obtained by Pulse suggest practices are...

Clinical leadership in disarray.
July 23, 2008... Survey reveals concerns over pay and training as doubts surface over funding for Lord Darzi's leadership revamp By Steve Nowottny Clinical leadership is in disarray, with poorly paid and undertrained GP leaders often denied a real say...

Journal watch: ABI aids CVD prediction.(ankle brachial index )(cardiovascular disease )
July 23, 2008... Combining ankle brachial index (ABI) with the Framingham risk score improves predictive accuracy for cardiovascular disease and mortality, a meta-analysis by a multinational team of researchers reports. The analysis examined 10-year...

Journal watch: SSRIs linked to GI bleeds.
July 23, 2008... Patients using SSRIs or venlafaxine are at a significantly raised risk of having upper gastrointestinal bleeding, a Spanish study using UK general practice data has found. An analysis of 1,321 patients referred to a consultant because of...

Journal watch: HRT risks assessed.
July 23, 2008... HRT increases the risk of stroke and venous thromboembolism (VTE), but not of CHD, a meta-analysis by UK researchers reports. In 31 randomised controlled trials involving 44,113 women, HRT was associated with a 32% increased risk of stroke...

Online ratings of GPs may be used by GMC.
July 23, 2008... Comments on controversial website could count towards revalidation By Steve Nowottny Comments posted on a website allowing patients to rate their GP could be used in the GMC's revalidation process and may even be quoted in...

Patient postings cause uproar.
July 23, 2008... More than 2,500 patients rated their doctor the day the website was launched, and although many gave rave reviews, others were less complimentary. One GP in Wirral was accused of being `arrogant' and treating his patients like...

Vaccine evidence mounts.
July 23, 2008... Evidence appears to be building for the introduction of vaccines against varicella zoster and rotavirus, both of which are being assessed by Government advisers. The Joint Committee on Vaccination and Immunisation is evaluating evidence on...

Doubt cast on chlamydia screening basis.
July 23, 2008... A review has questioned the basis for the national chlamydia screening programme, after finding an `absence of evidence' for the belief that the infection raises the risk of infertility. Chlamydia screening is now on the fourth wave of its...

Media Watch: This week's top... Miracle cure.
July 23, 2008... Some good news at last for those patients who tend to avoid hospital like, well, the plague. MRSA superbugs, the modern equivalent, will have nowhere to hide if new vaccines being developed by scientists succeed. The Government's chief medical...

Media Watch: This week's top... Scare story.
July 23, 2008... As if ruining our summer was not enough, clouds also make us fat, according to the Daily Mail and Telegraph. Scottish researchers, who should know these things, claim the lack of sunlight in the northern hemisphere means we don't have enough...

Media Watch: This week's top...most pointless research.
July 23, 2008... Lack of sleep is bad for your brain. In research that can be confirmed by any GP who has done out-of-hours, depriving yourself of sleep impairs your ability to remember details and recall how to conduct new tasks. The research did not...

Substance misuse: Sharp rise in practices treating drug misuse.
July 23, 2008... Increase prompts warning of `excessively liberal' methadone prescribing By Nigel Praities GPs are being thrust into the front line against drug misuse, new figures show. Almost 40% of all practices are involved in the treatment of...

Substance misuse: Brief intervention helps to lower excessive drinking.
July 23, 2008... Plans to pay GPs to screen and treat people for alcohol misuse have been backed by researchers on a new gold standard review, who concluded brief interventions in primary care were effective at reducing drinking. The Cochrane Drugs and...

Cuts prompt homeopathy scripts plunge.
July 23, 2008... Exclusive By Nigel Praities GP prescriptions for homeopathy have almost halved in two years, placing a huge question mark over future provision of the controversial treatment. Figures obtained by Pulse from the Prescription...

Focus on... PCTs' capacity to deliver.(primary care trusts)(Survey)
July 23, 2008... Three years after a brutal series of PCT mergers, GPs still lack confidence in the managerial abilities of their trusts By Gareth Iacobucci It is three years almost to the day since an NHS night of the long knives resulted in a brutal...

Debate: Should GPs embrace practice accreditation?
July 23, 2008... YES Practice accreditation is about professionalism and standardising quality - not a stick to beat GPs with - insists RCGP chair Professor Steve Field Patients have the right to expect high-quality care from their practice. In the...

LETTER: Nothing gentlemanly in Bradshaw claims.(Letter to the editor)
July 23, 2008... From Dr Yealand Kalfayan, Bristol You report health minister Ben Bradshaw as claiming that closed lists and limited practice boundaries were evidence of a `gentlemen's agreement' not to compete for patients (`GPs to be paid to battle for...

LETTER: No place for protectionism in skin surgery.(Letter to the editor)
July 23, 2008... From Dr Soon Lim Educational director, minor surgery, Bedfordshire and Hertfordshire faculty, RCGP The latest criticism of GP skin cancer surgery is just protectionism wrapped up as evidence-based medicine (`Skin cancer audits fuel minor...

LETTER: Co-payments undermine NHS principles.(Letter to the editor)
July 23, 2008... From Dr Kailash Chand Ashton-under-Lyne, Greater Manchester Open letter to Alan Johnson You very rightly say: `As we look back on 60 years of the NHS, the overwhelming feeling is one of grateful thanks to the legions of doctors,...

LETTER: Sixty years on and we're back to square one.(Letter to the editor)
July 23, 2008... From Dr John Cormack South Woodham Ferrers, Essex As we `celebrated' the 60th anniversary of the NHS, we found our practice had come full circle. Before 1948, people who couldn't afford healthcare were dependent on charity. In this...

LETTER: Our patients do not want polyclinics.(Letter to the editor)
July 23, 2008... From Dr Krishna Chaturvedi Westcliff-on-Sea, Essex I would like to congratulate Pulse for running the Save Our Surgeries campaign, which puts the spotlight on the cheap, vote-gaining politics of polyclinics. Strangely - or perhaps not...

LETTER: It's up to PCTs to sort out OOH.(Letter to the editor)
July 23, 2008... From Dr Tim Southwood, Bristol If PCTs are making such a mess of out-of-hours provision then they must sort it out. Not having to work out of hours is the most significant improvement in general practice since the founding of the NHS....

LETTER: Clarification on clopidogrel analysis.(Correction notice)(Letter to the editor)
July 23, 2008... From Julian Wood Marketing and communications director, National Audit Office Your in-brief `Drive to cut clopidogrel prescribing flawed' (pulsetoday.co.uk/news) misrepresents the paper published in the Journal of Public Health. You...